[Médecine Tropicale et Santé Internationale takes a stand against editorial predation]. / Médecine Tropicale et Santé Internationale s'engage contre la prédation éditoriale.

Warnings against predatory journals get stronger. Designed to capture manuscripts with the promise of rapid publication, the main aim of these journals is to charge abusive publication fees. Sometimes boasting imaginary impact factors, they are not indexed and offer no guarantee of visibility, accessibility or durability of the published article. Above all, they have no concern for the rigor and scientific integrity of the work they publish.

Mycobacterium malmoense: an underestimated nontuberculous mycobacterium.

We present a case report of Mycobacterium malmoense in a 53-year-old white man. The incidence of M. malmoense infections is a rare event compared with other nontuberculous mycobacteria, but it has increased since 1980, especially in northern Europe. Many patients have disposing underlying diseases. In most cases, it is a pulmonary infection. The most frequent used antibiotics are rifampicin (or rifabutin), ethambutol, and clarithromycin.

[Leptospirosis]. / Leptospirose.

Leptospirosis is among the most important zoonotic disease worldwide. Annually, millions of human cases occur worldwide, with case fatality rates ranging as high as 20-25% in some regions. The pathogenicity of the Leptospira spp is depending on the responsible serovar. Rodents are the most important primary hosts but a wide range of other mammals are also able to carry and transmit the disease as secondary hosts. Humans become infected directly through infected animal contact or indirectly with water, food, or soil containing urine from these infected animals. The main route of infection is the skin through skin abrasions, more rarely through mucosa contact and exceptionally by respiratory or digestive route. The diagnosis should be evoked on a detailed personal history evoking epidemiological context with consistent clinical and biological results. A lot of infected persons may have no symptoms at all showing a minor illness. In most cases symptoms are flu-like with fever, headache and intensive myalgia associated with hepatic cytolysis, proteinuria and thrombocytopenia. In France, the most common clinical presentation combines liver involvement and jaundice with kidney involvement. However, other sites can be involved (brain, heart and lung). The diagnosis is often obtained several weeks later by serology. Treatment for leptospirosis is based on an early antibiotic therapy with amoxicillin, or tetracycline in case of allergy, but it remains controversial whether antimicrobials produce a beneficial effect in mild human leptospirosis. For at-risk occupations, preventive treatment recommends eviction or limitation of exposure, and vaccination.

Clinical aspects and prognostic factors of leptospirosis in adults. Retrospective study in France.

BACKGROUND: Because early recognition and initiation of antibiotic therapy are important, clinicians should familiarize themselves with the clinical presentation of leptospirosis, and determine prognostic factors. PATIENTS AND METHODS: This study included all patients treated at Angers University Hospital between January 1995 and December 2005 for leptospirosis - both probable (cases combining epidemiologically suggestive features with compatible clinical, laboratory, and radiographic findings, with no other diagnosis envisioned) and confirmed (by finding microorganism on direct examination or culture of blood, urine or CSF, or by seroconversion or by a significant increase in the antibody titer between two samples). Severe leptospirosis was defined by hospitalization in the critical care department or need for renal dialysis. The statistical analysis used SPSS software version 12. RESULTS: Of 97 records reviewed, we retained 62 cases that met the criteria above, including 35 confirmed cases, 27 probable and 15 severe. The sex ratio was nine men for every woman. The patients' mean age was 45+/-18 years [12-77]. The principal clinical signs observed were: fever (n=59) with shivering (n=42), diffuse myalgia (n=41), headaches (n=38), jaundice (n=24), conjunctival suffusion (n=10), rash (n=11), herpes eruption (n=7), renal damage (n=33) that was sometimes severe (>500 micromol/L) (n=7), meningitis (n=12), meningoencephalitis (n=2), myocarditis or pericarditis (n=6), and atypical radiographic lung disease (n=16), sometimes with ARDS (n=6). Blood tests showed thrombocytopenia (platelets<140 G/L) in 65.5% of patients (n=40). Logistic regression modeling showed that two criteria remained independently predictive of development toward severe leptospirosis: clinical jaundice (p=0.005) and cardiac damage seen either clinically or on ECG (p<0.02). These factors can be identified easily at the first clinical examination and during evolution, and should help to reduce mortality by allowing earlier management of patients with suspected leptospirosis.

[Botulism, a clinical diagnosis]. / Botulisme, un diagnostic clinique.

Foodborne botulism results from the effect of a neurotoxin produced by a sporulated anaerobic bacillus called Clostridium botulinum. The mode of contamination occurs through the consumption of foodstuff, already contaminated by the neurotoxin. Following an incubation period that varies from 2 hours to 8 days, the symptoms start with intestinal problems. Then paralysis of the cranial nerve pairs sets in, classically manifested by diplopia, dysphagia, dysphonia, areactive mydriasis and ptosis. The onset of motor disorders occurs in descending order with possible involvement of the respiratory muscles, hence requiring reanimation measures and sometimes mechanical ventilation. The diagnosis of botulism is clinical. Identification of the botulinum toxin in the blood or faeces of the patients or in the contaminating food stuff confirms the diagnosis.

[Foodborne botulism, epidemiologic aspects]. / Botulisme alimentaire, aspects epidémiologiques.

With a mean of 30 cases reported per year, following Italy, France ranks second in the European countries in terms of incidence of botulism. Food stuff of commercial origin, of artisanal or industrial manufacture fabrication, is increasingly implicated in the genesis of outbreaks of botulism. Moreover, the modern methods of conserving food (vacuum packed food, frozen food...) allow the development of Clostridium bacteria. The diversification of the risks related to the type of products incriminated and to the new conservation methods, associated with the extension of commercial exchanges, result in the risk of widespread internationally outbreaks of botulism.

[Foodborne botulism, prevent and treatment]. / Botulisme alimentaire, prévention et traitement.

The United States and Europe agree that the treatment of botulism is based on symptomatical measures and, notably, on mechanical ventilation when the respiratory function is impaired. Opinions diverge regarding the specific treatment represented by anti-botulinum serum: used systematically in the United States and frequently in many European countries, France never uses it other than in a few cases. Identification of the contaminating foodstuff is a fundamental element in limiting extension of the disease. Reducing the delay in declaration and the identification and correction of bad cooking practices would help to reduce the number of cases of botulism.

Vascular thrombosis and acute cytomegalovirus infection in immunocompetent patients: report of 2 cases and literature review.

Acute cytomegalovirus (CMV) infection in immunocompetent patients is common worldwide, with seroprevalence rates of 40%-100%, depending on the country, socioeconomic conditions, and the patient's age. Infection is most often asymptomatic, but acute cytomegalovirus infection is occasionally revealed by prolonged fever, cervical lymphadenitis, and arthralgia, and it is more rarely revealed by pneumonia, myocarditis, pericarditis, colitis, and hemolytic anemia. Here, we report 2 cases of acute CMV infection in nonimmunocompromised adults that were complicated by venous thrombosis with pulmonary embolism. We also review previously reported cases of vascular thrombosis and discuss the propensity of CMV to induce vascular damage with associated thrombosis.

[Hepatosplenic localization of cat scratch disease in immunocompetent adults. Two cases]. / Localisations hépatospléniques de la maladie des griffes du chat chez l'adulte immunocompétent. Deux cas.

The infective agent responsible for cat scratch disease, Bartonella henselae, is a rare cause of hepatic granulomatosis in immunocompetent adults. Clinical features include a prolonged fever or more typical symptoms such as lymphadenopathy associated with painful hepatomegaly and a fever following a cat scratch or bite. Images of micronodular hepatosplenic lesions on abdominal ultrasonography or computed tomography scan along with epithelioid granulomas in a liver biopsy can suggest this diagnosis. It is established with a serology by indirect immunofluorescence or by ELISA and/or the presence of Bartonella henselae DNA evidenced by PCR in the liver biopsy. We report two cases of hepatosplenic localizations of cat scratch disease in a 41-year-old woman and a 44-year-old man presenting asthenia and fever associated with a biological inflammatory syndrome and elevated liver enzymes.